Career ladder Development System in Nursing Management Kumiko Igarashi, RN, Ph.D Chief Advisor / Expert in Nursing Administration The project for enhancement of Nurses Competencies through In-Service Training JICA

Demographic and epidemiologic transition : Rapid increase NCDs and aging population UHC towards 2019, start from 2014 : Improvement of primary care and referral system Globalization : - Requiring international standard of care service for patient safety: JCI - Trade in services : WTO, GATS, MRA, EPA Improving quality and safety of care service Strengthening ability and function of human recourses for health Tightening of regulations Strengthening promotion, coordination, supervising for care providers Strengthening PPP Policy Strategies Emerging Challenges in Health Challenges and Policy Strategies in Health Sector in Indonesia

Practice Training according to Level Competency Assessment High Quality Nursing Care Services Improve competencies of nurses Conduct Trainings (CPD) ? Improper Training Program Unclear Target of participants No motivations for nurses No standard training curriculum Ineffective Human Recourse Management System No acknowledgement of nurses competencies in the Hospital ?

CONCEPT OF THE CAREER DEVELOPMENT LADDER SYSTEM Principal Components of Career Ladder System for nurses Evaluation based on competency Education Continuing Professional Development Correspondence based on the evaluation Individual Objectives Strengthening the nursing competencies for individual nurses while meeting their job satisfaction Mission of organization Developing human recourses for nurses with ability to provide appropriate nursing care services in line with mission and visions of each institution Acknowledge of the value on clinical practice Motivation to become mature nurses

Practice Ladder for Clinical Nurses PK1 PK2 PK3 PK4 PK5 Ability to perform basic nursing care under supervision Ability to perform comprehensive nursing care independently Ability to perform comprehensive nursing care in a specific area and manage the nursing unit Ability to perform nursing care with cases requiring specialized approach to inter and multidisciplinary clinical governance Ability to consult in a specific area of nursing care and clinical governance Assessment ↓ Accreditation ↓ Certification AACAAC AACAAC AACAAC AACAAC Training Target: Capacity for PK2 Training Target : Capacity for PK3 Training Target Capacity for PK4 Training Target Capacity for PK5 What is Next ? Practice

LevelPK １ PK2PK3PK4PK5 PracticeKnowledge Skill Attitude ManagementKnowledge Skill Attitude EducationKnowledge Skill Attitude ResearchKnowledge Skill Attitude Indicators Matrix of Competency of Assessment for Clinical Nurses each PK Develop instrument of assessment for each PK based on indicators Assessment should be standardize with minimum requirement of competencies for each PK. When nurse moves to deferent ward or different Hospital, hospital can know about their capacity and easy to manage the staff career.

Benner’s Model Benner identified five levels of nursing practice in 1984: novice, advanced beginner, competent, proficient and expert. Her work prompted an increased interest in clinical ladders by providing a “clearer and more detailed theoretical underpinning for the use [of clinical ladders], and assisted in refining their application and practice” (Buchan, 1999).